| NPI | 1447699525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.130678) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2013017842) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2020-05-05 |