| NPI | 1861132805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.150481) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME177143) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-12-11 |