| NPI | 1306406863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.146959) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 23856) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2025-12-22 |