| NPI | 1376802231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2020-00454) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.125378) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2023-08-21 |