| NPI | 1982966644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.120265) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.120265) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2014-01-14 |