| NPI | 1841856507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 009489) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.030991) |
| 207P00000X Emergency Medicine (Licence: NM DO2023-0060) | |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2026-06-02 |