| NPI | 1689697625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: OH 35067590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35067590H) |
| 207Q00000X Family Medicine (Licence: AL 29742) | |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: AL 29742) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2009-10-22 |