| NPI | 1720308125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.010912) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: HI DOS 1540) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2019-07-01 |