| NPI | 1144806506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.017375) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207P00000X Emergency Medicine (Licence: MD H0097916) | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-02-09 |