| NPI | 1174508014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 42113) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35072821M) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2016-07-15 |