| NPI | 1225655780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4351049802) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.153757) |
| 101Y00000X Counselor | |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2025-06-30 |