| NPI | 1023455441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OH 35049656) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OH 35049656) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2013-05-24 |