| NPI | 1871539338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 18705) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-086498) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-04-06 |