| NPI | 1497289821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.014270) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT017658) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2023-08-25 |