| NPI | 1619120334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 02004158A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34-009941) |
| 207P00000X Emergency Medicine (Licence: NC 2011-00430) | |
| Enumeration Date | 2008-10-25 |
| Last Update Date | 2021-02-03 |