| NPI | 1366651481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 6456430-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 88435) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-11-21 |