| NPI | 1184603987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.094276) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101235233) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2024-04-10 |