| NPI | 1639864283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.154400) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301518283) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-06-22 |