| NPI | 1083662431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35077061L) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 39737) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-04-15 |