| NPI | 1265768873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 58.003383) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.010664) |
| 207P00000X Emergency Medicine (Licence: NC 2012-01702) | |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2012-09-06 |