| NPI | 1265810782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 278934) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.133038) |
| Enumeration Date | 2015-05-16 |
| Last Update Date | 2022-06-02 |