| NPI | 1497169171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 298204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021977) |
| 207P00000X Emergency Medicine (Licence: OH 34.012963) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2025-09-21 |