| NPI | 1497954457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 255957) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.002095) |
| 207P00000X Emergency Medicine (Licence: OH 34.009341) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 255957) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2023-07-22 |