| NPI | 1144516352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 0000000000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098885) |
| Enumeration Date | 2011-06-26 |
| Last Update Date | 2012-10-19 |