| NPI | 1881114999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2020-02850) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3486) |
| 207P00000X Emergency Medicine (Licence: OH 58.029804) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2020-06-22 |