| NPI | 1730169822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34006231) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 000003) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2020-09-29 |