| NPI | 1124045752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036-090895) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 2666) |
| 207P00000X Emergency Medicine (Licence: MO 107364) | |
| 207P00000X Emergency Medicine (Licence: OH 25.067203) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2009-05-13 |