| NPI | 1326448127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.016690) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.030923) | |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2023-07-12 |