| NPI | 1457705147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A18220) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.013641) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2021-10-04 |