| NPI | 1619464260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 9445) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.014118) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2022-04-25 |