| NPI | 1568043222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 82870) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.149176) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2024-08-15 |