| NPI | 1871541201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 17964) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.071985) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-02-06 |