| NPI | 1811375900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.012400) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 67079) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2020-05-27 |