| NPI | 1518101120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.136847) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 25785) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2019-09-17 |