| NPI | 1467458745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 48540) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35078105) |
| 207P00000X Emergency Medicine (Licence: IN 01075760A) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2026-08-05 |