| NPI | 1598142622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 82059) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.013822) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2026-01-09 |