| NPI | 1639690605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.015322) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101023615) |
| 207P00000X Emergency Medicine (Licence: MI 5151009691) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2021-08-04 |