| NPI | 1053815035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.014157) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T3020) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2024-06-21 |