| NPI | 1790197689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.131971) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301105421) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2022-12-15 |