| NPI | 1073756359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO160999) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID 7281913) |
| 207P00000X Emergency Medicine (Licence: OH 010492) | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2026-06-29 |