| NPI | 1407806425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.123790) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301073415) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2022-09-27 |