| NPI | 1790191807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2017040033) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.012018) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2018-12-27 |