| NPI | 1639182397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 25971) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35C.002482) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2026-08-26 |