| NPI | 1215916275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.009741) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3131) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2020-07-14 |