| NPI | 1609070655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.092917) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 205211) |
| 207P00000X Emergency Medicine (Licence: MS 22018) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2019-11-20 |