| NPI | 1881124816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101025046) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34C.000547) |
| 207P00000X Emergency Medicine (Licence: IL 036171615) | |
| 207P00000X Emergency Medicine (Licence: IN 02006388A) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2025-12-30 |