| NPI | 1780662411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2006-01265) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.086533) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2019-07-29 |