| NPI | 1245382241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35043814) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD441854) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-07-08 |