| NPI | 1164816633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.013077) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 343675) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2025-02-20 |