| NPI | 1194216101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.141973) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301501047) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2021-11-04 |