| NPI | 1417958265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.082052) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2006-01133) |
| 207P00000X Emergency Medicine (Licence: SC 31469) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2021-02-17 |