| NPI | 1023683638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 99994) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.150395) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2024-06-21 |