| NPI | 1598086373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO161765) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.003141) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2020-11-12 |