| NPI | 1679644025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 235235) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.088695) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2010-02-25 |