| NPI | 1972765253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.124189) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2020-0058) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2020-01-31 |