| NPI | 1780241927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME167587) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.147823) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2024-08-07 |