| NPI | 1306253422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV ED0443A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 632260) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-11-23 |