| NPI | 1306208921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 75162-20) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.135979) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2022-06-07 |