| NPI | 1124645403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 58.035335) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03439710) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2026-03-25 |