| NPI | 1902983034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.152808) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 43002) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-04-14 |