| NPI | 1790166924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.144296) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD467616) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2023-11-03 |