| NPI | 1720406887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 127063) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 62550) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2020-01-23 |