| NPI | 1548456262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 126518) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 49276) |
| 207P00000X Emergency Medicine (Licence: MT 11719) | |
| Enumeration Date | 2007-09-16 |
| Last Update Date | 2015-08-03 |