| NPI | 1255318507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35062606M) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 14521) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2021-12-27 |