| NPI | 1922278852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.092353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301090897) |
| 207P00000X Emergency Medicine (Licence: IN 01065803A) | |
| 207Q00000X Family Medicine (Licence: WI 52437-020) | |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2010-11-19 |