| NPI | 1508070145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N0167) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.088399) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-01-18 |