| NPI | 1902214489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 4233) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.005361) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2021-05-25 |