| NPI | 1780895078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301095308) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57011085) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2025-11-04 |