| NPI | 1790762888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q2348) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35073075) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OH 35073075) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2015-05-28 |