| NPI | 1851822035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 29757) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.137051) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2021-08-31 |