| NPI | 1770283590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.017401) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 34.017401) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2025-07-16 |