| NPI | 1871913251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.012219) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 2868-321) |
| 207P00000X Emergency Medicine (Licence: MO 2025030574) | |
| 207P00000X Emergency Medicine (Licence: IA DO-06738) | |
| 207P00000X Emergency Medicine (Licence: IN 02007604A) | |
| 207P00000X Emergency Medicine (Licence: IL 036168086) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2025-09-04 |