| NPI | 1154770063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.150683) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301109339) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2024-07-03 |