| NPI | 1164009791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301516163) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.149994) |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2026-06-08 |