| NPI | 1306339486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME169580) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.146732) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2024-08-28 |