| NPI | 1962721050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.125265) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101255621) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2025-03-07 |