| NPI | 1245675925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.011101) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 34.011101) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2020-04-13 |