| NPI | 1740624899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34012099) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3189) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2022-07-21 |