| NPI | 1962459529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 50.000914RX) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 50000914) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2018-07-02 |