| NPI | 1154388395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NC 2006-00558) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35085232) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2016-02-18 |