| NPI | 1972299691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.154248) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: OH 35.154248) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2026-06-17 |