| NPI | 1518169986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35089675) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 22629) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2021-04-15 |