| NPI | 1649258195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 239927) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35086810) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2016-02-29 |