| NPI | 1104445253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-141522) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.145371) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2024-08-01 |