| NPI | 1124214366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ND 12787) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35094101) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2021-02-14 |