| NPI | 1821036062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL PA9102019) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50. 002438) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2007-07-08 |