| NPI | 1063674075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OH 35.125338) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301092662) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2017-03-11 |