| NPI | 1801161161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME128122) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.124136) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2016-07-13 |