| NPI | 1457813578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 63973) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.143972) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2023-06-21 |