| NPI | 1003194085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 61446) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME119337) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2022-12-27 |