| NPI | 1306292115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.146222) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 53857) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2026-05-14 |