| NPI | 1417916487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.099809) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 39166) |
| 207P00000X Emergency Medicine (Licence: MD D64924) | |
| 207P00000X Emergency Medicine (Licence: VA 0101236068) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2019-07-16 |