| NPI | 1609095447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 57012526) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N2284) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2009-03-20 |