| NPI | 1740483122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R5027) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.008507) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2018-11-26 |