| NPI | 1164720785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 26900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57.017842) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2022-04-20 |