| NPI | 1679567523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 37837) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.098156) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2013-06-19 |