| NPI | 1992761159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.068409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.068409) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2013-05-17 |