| NPI | 1043897655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.018484) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 76725) |
| 207P00000X Emergency Medicine (Licence: WI 81486) | |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2026-08-12 |