| NPI | 1871937763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.128888) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q7770) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2016-09-30 |