| NPI | 1376586396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 21930) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.084607) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2025-03-20 |