NPI | 1306834809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.010641) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN AT 0000000793) |
Enumeration Date | 2005-10-10 |
Last Update Date | 2012-08-10 |