| NPI | 1972064012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: OH 35.144962) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 75292) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2022-10-23 |