| NPI | 1356398101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35-04-0860) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 15270) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2011-10-24 |