| NPI | 1235495862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID O-0855) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.011116) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2015-05-18 |