| NPI | 1780775643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD47458) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-075451) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-03-26 |