| NPI | 1134668700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.013897) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02005970B) |
| 207P00000X Emergency Medicine (Licence: WV 3593) | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2020-07-30 |