| NPI | 1124554399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 301583) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.015410) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2024-08-09 |