| NPI | 1083800361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: OH 34.009681) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OH 34.009681) |
| 207R00000X Internal Medicine (Licence: OH 34.009681) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2026-04-08 |