| NPI | 1174752703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.132965) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301094240) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2023-02-28 |