| NPI | 1649566621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.011678) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101019557) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2026-08-17 |