| NPI | 1366580110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.128371) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 32079) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2021-05-17 |