| NPI | 1952415663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.038821) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 35038821) |
| 207P00000X Emergency Medicine (Licence: OH 35.038821) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2015-08-12 |