| NPI | 1205297645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 12309866-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.013732) |
| Enumeration Date | 2016-03-13 |
| Last Update Date | 2022-05-12 |