| NPI | 1104016567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 11989) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57011793) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2023-11-27 |