| NPI | 1053500256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 15602) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35096975) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2012-07-10 |