| NPI | 1972184901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.149733) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OH 35.149733) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AZ 72410) | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2024-07-26 |