| NPI | 1740543024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34011850) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3098) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-07-10 |