| NPI | 1184030454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 007498) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.012135) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2018-08-31 |