| NPI | 1558363143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 95624) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35081291) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2026-02-19 |