| NPI | 1669534780 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101015484) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.010114) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2022-01-07 |