| NPI | 1164915559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.014881) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3937) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2023-02-10 |