| NPI | 1578587093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL MD.28660) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35049516) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-01-23 |