| NPI | 1083741656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.1124272) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C70003216) |
| 207P00000X Emergency Medicine (Licence: MI 4301104661) | |
| 207P00000X Emergency Medicine (Licence: NY 249082-1) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2015-06-25 |