| NPI | 1881686871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2006-01424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34008394) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2017-04-21 |