| NPI | 1114008810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME110820) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35071031) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-01-15 |