| NPI | 1366757734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301097205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.122208) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2023-05-19 |