| NPI | 1508064759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME138800) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.121070) |
| 207P00000X Emergency Medicine (Licence: MD D66303) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2020-10-08 |