| NPI | 1376777953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 315406) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.098285) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2022-11-17 |