| NPI | 1053382275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35052675F) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35052675F) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2008-03-07 |