| NPI | 1154770337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4351030385) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35155110) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2026-02-17 |