| NPI | 1134495658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 1134495658) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.136054) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2023-08-24 |