| NPI | 1154747657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 54968) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036.156045) |
| 207P00000X Emergency Medicine (Licence: OH 35.128034) | |
| 208D00000X General Practice (Licence: OH 128034) | |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2022-08-10 |