| NPI | 1750570917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2009008956) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.009111) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2015-03-30 |