| NPI | 1578509311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV I09214) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34-00-7861-S) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2007-07-16 |