| NPI | 1083239081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 57.257157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11978) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2024-07-28 |