| NPI | 1710963947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.070350) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 20670) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2021-07-13 |