| NPI | 1811944804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.006789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1297) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2015-02-09 |