| NPI | 1629048616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35095083) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0101235321) |
| 207P00000X Emergency Medicine (Licence: NY 248360) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2010-05-11 |