| NPI | 1538330360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.092848) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301087597) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2009-10-27 |