| NPI | 1114345378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 04886) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021413) |
| 207P00000X Emergency Medicine (Licence: OH 34.014007) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2024-03-19 |