| NPI | 1659638997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.125826) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 276649) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2020-05-06 |