| NPI | 1154688349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2015-01641) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.126535) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2019-05-29 |