| NPI | 1982349288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.017457) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 4811) |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2025-11-24 |