| NPI | 1508272220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.014850) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA DO-05250) |
| 208600000X Surgery (Licence: MI 5101021437) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2023-05-16 |