| NPI | 1295129922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60948231) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.007065) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2019-07-03 |