| NPI | 1871937805 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.133555) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301103575) |
| Enumeration Date | 2013-04-21 |
| Last Update Date | 2019-06-03 |