| NPI | 1679217277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 61894) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.152566) |
| 207P00000X Emergency Medicine (Licence: TN 70093) | |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2026-07-08 |