| NPI | 1467592352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 50-002236) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-002236) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-07-08 |