| NPI | 1144890880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.154318) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 31998) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2025-07-18 |