| NPI | 1962609164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34010016) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 262845) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2011-09-30 |