| NPI | 1174017180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.017663) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02006673A) |
| 207P00000X Emergency Medicine (Licence: MI 5101026354) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2025-03-05 |