| NPI | 1902039647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 264683) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.009869) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2026-03-05 |