| NPI | 1326467580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME130878) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.129173) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-01-21 |