| NPI | 1053931618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD229079) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.147338) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2026-07-21 |