| NPI | 1689865834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME140365) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.094513) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-03-22 |