| NPI | 1902486699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 92638) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.032219) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2026-03-06 |