| NPI | 1891148326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD470074) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.152593) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2025-03-24 |