| NPI | 1124003157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35 062409E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 35062409E) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2023-05-24 |