| NPI | 1174190227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.016286) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5151015278APP21) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-06-17 |