| NPI | 1063633477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2007007772) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34008868) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-18 |