| NPI | 1255530283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 56164) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH B09667710-607-15) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2022-03-30 |