| NPI | 1467571711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101016059) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.015084) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2021-05-18 |