| NPI | 1922205889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 018235) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.130562) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2022-11-30 |