| NPI | 1720128614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 50.000363) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2015-05-15 |