| NPI | 1215918768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35076906L) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD456894) |
| 207P00000X Emergency Medicine (Licence: NY 282627) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2019-02-08 |