| NPI | 1700844040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 29079) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01084567A) |
| 207P00000X Emergency Medicine (Licence: OH 35063982K) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-07-07 |