| NPI | 1912448762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2021-02375) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.014802) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2021-12-01 |