| NPI | 1174782072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.009443) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH temp license) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2010-07-12 |