| NPI | 1891016986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.125649) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: IN 01070626A) | |
| Enumeration Date | 2010-06-12 |
| Last Update Date | 2024-02-19 |