| NPI | 1124006671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD27144) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35075203) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2020-09-30 |