| NPI | 1447517677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.145259) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2015008500) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2022-07-21 |