| NPI | 1619596103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102208470) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.016033) |
| 207Q00000X Family Medicine (Licence: OH 34.016033) | |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2024-07-09 |