| NPI | 1760689046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 373427-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.002313) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2009-11-04 |