| NPI | 1649202250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301052677) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-063491) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2016-01-08 |