| NPI | 1043417652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine Critical Care Medicine (Licence: OH 35093364) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301090602) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2023-11-03 |