| NPI | 1114554623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 58.034467) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH LPN.171600) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-08-19 |