| NPI | 1598772881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35067266) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 29280) |
| 207Q00000X Family Medicine (Licence: OH 35067266) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2025-07-08 |