| NPI | 1528622057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1015651) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.030787) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2023-07-17 |