| NPI | 1700413382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.153404) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 331302) |
| 207R00000X Internal Medicine (Licence: LA 331302) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-07-03 |