| NPI | 1174903280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.139394) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301502273) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2024-03-21 |