| NPI | 1649664228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.136235) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 28394) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2023-05-31 |