| NPI | 1902007453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101245842) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57010630) |
| 207P00000X Emergency Medicine (Licence: MI 4301097903) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2011-07-29 |