| NPI | 1134318298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 58.001515) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02003861A) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2020-02-24 |