| NPI | 1700087392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO2545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58002205) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2019-07-08 |