| NPI | 1639338940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.097983) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 53475-20) |
| 207P00000X Emergency Medicine (Licence: PA MD453239) | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2016-01-05 |