| NPI | 1063899078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.013886) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021527) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2022-02-16 |