| NPI | 1760824858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 04258) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.005842) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2023-09-13 |