| NPI | 1861497463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 16777) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01057154A) |
| 207P00000X Emergency Medicine (Licence: OH 35072084) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2024-08-22 |