| NPI | 1942343348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34009509) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101015861) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-08-22 |