| NPI | 1508494618 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.017067)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.076055)  | 
| 207P00000X Emergency Medicine (Licence: IL 036.165179)  | |
| Enumeration Date | 2020-04-01 | 
| Last Update Date | 2025-05-07 |