| NPI | 1790769545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 83418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.016136) |
| 207P00000X Emergency Medicine (Licence: IN 02006247A) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 5101013885) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2024-08-22 |