| NPI | 1972161842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.145299) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301505683) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2024-10-21 |