| NPI | 1265473557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS12683) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34007419) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2015-03-13 |