| NPI | 1063487544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35-055642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD032892E) |
| 207Q00000X Family Medicine (Licence: OH 35055642) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2009-06-30 |