| NPI | 1093207060 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 4505)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.015477)  | 
| Enumeration Date | 2018-06-05 | 
| Last Update Date | 2025-03-18 |