| NPI | 1558555292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS6741) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS6741) |
| 207P00000X Emergency Medicine (Licence: OH 34001900) | |
| 207Q00000X Family Medicine (Licence: OH 34001900) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-09-05 |