| NPI | 1639105422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102202823) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34-00-6988-W) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2022-06-08 |