| NPI | 1609847722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD150279) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-046219) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2014-05-21 |