| NPI | 1013175835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34-010094) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT011707) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2021-04-13 |