| NPI | 1588397137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.017517) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT022191) |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2025-02-06 |