| NPI | 1912904293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35077810) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 33604) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2011-04-08 |