| NPI | 1164454948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 079624) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35C.001199) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-02-08 |