| NPI | 1982233953 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 57.250174) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD216272) | 
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: OR PG216180) | |
| Enumeration Date | 2020-04-02 | 
| Last Update Date | 2024-11-25 |