| NPI | 1619292307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 21117) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34-009791) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2016-10-31 |