| NPI | 1275945016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34013214) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020862) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2022-05-22 |