| NPI | 1942628144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME132233) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 127768) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2017-07-03 |