| NPI | 1255606125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS16814) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 011276) |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2020-06-05 |