| NPI | 1134547821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0085302) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 131081) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2018-08-02 |