| NPI | 1912392523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: KY 55302) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 55302) |
| 207P00000X Emergency Medicine (Licence: OH 35.134768) | |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY 55302) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2025-09-15 |