| NPI | 1356752984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R5625) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.012393) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2019-11-21 |