| NPI | 1205882776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA 0S010877) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.010588) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-08-16 |