| NPI | 1164684502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 13994) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 95651) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2011-11-02 |