| NPI | 1447833504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35150486) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 59124) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: IN 01098271A) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: OH 35150486) | |
| 207P00000X Emergency Medicine (Licence: IN 01098271A) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: KY 59124) | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2025-11-03 |