| NPI | 1457911190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301506956) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301506956) |
| 207P00000X Emergency Medicine (Licence: OH 57.247892) | |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2024-06-17 |