| NPI | 1730442369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34011757) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 2890) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-08-03 |