| NPI | 1093343063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV CS35463) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35C.002981) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-10-22 |