| NPI | 1124318282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 63608) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.122875) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2018-05-01 |