| NPI | 1174836019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT014428) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.010796) |
| 207P00000X Emergency Medicine (Licence: NY 271509) | |
| 208D00000X General Practice (Licence: WV 2550) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2020-10-02 |