| NPI | 1710514500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.156138) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301513487) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301513487) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-05-19 |