| NPI | 1023466950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.136555) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 1255) |
| 207R00000X Internal Medicine (Licence: OH 35.136555) | |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2021-04-22 |