| NPI | 1366002735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5151014003) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.016312) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2025-09-11 |