| NPI | 1962493304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.087318) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD427532) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2007-07-08 |