| NPI | 1902329121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.141952) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 74094) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2026-05-11 |