| NPI | 1679643845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2018-01191) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 31142) |
| 207P00000X Emergency Medicine (Licence: OH 35-068159) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2018-06-21 |