| NPI | 1538180732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.122206) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01072186A) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301065615) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2018-04-20 |