| NPI | 1386840197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX m6180) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35C.002125) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2025-05-02 |