| NPI | 1679738157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 009736) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 6646621) |
| 207P00000X Emergency Medicine (Licence: NC 2011-00629) | |
| 207P00000X Emergency Medicine (Licence: WV 3047) | |
| 207P00000X Emergency Medicine (Licence: MI 5101020859) | |
| 207P00000X Emergency Medicine (Licence: NY 277772) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2019-02-26 |