| NPI | 1477057883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.015793) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3742) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-06-24 |