| NPI | 1235757543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 57.248924) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.248924) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2021-08-09 |