| NPI | 1033799507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301513616) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.153653) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2026-04-16 |