| NPI | 1912978743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35047628) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: KY 22486) |
| 209800000X Legal Medicine (Licence: OH 35047628) | |
| 209800000X Legal Medicine (Licence: KY 22486) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2016-12-21 |