| NPI | 1699206664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.147271) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101273419) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-04-26 |