| NPI | 1184697989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: MI 4301509237) |
| Additional Taxonomies | 202K00000X (Licence: OH 35.120635) |
| 207P00000X Emergency Medicine (Licence: OH 35.120635) | |
| 207P00000X Emergency Medicine (Licence: NY 306066) | |
| 208D00000X General Practice (Licence: MI 4301509237) | |
| 207P00000X Emergency Medicine (Licence: FL ME144867) | |
| 207P00000X Emergency Medicine (Licence: PA MD049696L) | |
| 207P00000X Emergency Medicine (Licence: WV 25119) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2024-03-04 |