| NPI | 1518156710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 260208-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.093081) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2014-01-24 |