| NPI | 1376530188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N9692) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.085504) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2015-07-10 |