| NPI | 1770518813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2006-01160) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35C.004147) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-08-13 |