| NPI | 1922424506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.012936) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY TL5521) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2021-08-04 |