| NPI | 1679869705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A111160) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.097737) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2014-03-06 |