| NPI | 1790939973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.010548) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 4299) |
| 207P00000X Emergency Medicine (Licence: NE 910) | |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2012-07-05 |