| NPI | 1700873221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.009947) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101010571) |
| 207Q00000X Family Medicine (Licence: MI 5101010571) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2011-11-08 |