| NPI | 1396483251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.018161) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5151015782) |
| Enumeration Date | 2022-05-21 |
| Last Update Date | 2026-08-27 |