| NPI | 1508123894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD182755) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.126397) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2017-09-14 |