| NPI | 1740785898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.141763) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: OH 35141763) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2025-01-15 |