| NPI | 1578776100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R8291) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57012005) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2021-05-07 |