| NPI | 1912339888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.126649) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 35.126649) |
| 208600000X Surgery (Licence: OH 57.023307) | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2018-04-04 |