| NPI | 1780119867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.013591) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 011468) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2025-01-27 |