| NPI | 1740221589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.045256) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.045256) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2022-08-25 |