| NPI | 1356912273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 57.253845) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL17506) |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2022-12-15 |