| NPI | 1669477279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 29042) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35083639) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2015-07-30 |