| NPI | 1497980460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 40887) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35 099936) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2017-06-05 |