| NPI | 1659357127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 41478) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.084877) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2014-10-13 |