| 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 |