| NPI | 1720046022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 102699) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.000006) |
| 207Q00000X Family Medicine (Licence: MN 48126) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2025-04-09 |