| NPI | 1336177104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 105036) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35070847) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2026-02-02 |