| NPI | 1578805818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 04012) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.012322) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2024-06-04 |