| NPI | 1003298548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ND 17149) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 63466) |
| 207P00000X Emergency Medicine (Licence: WI 68985-20) | |
| Enumeration Date | 2015-06-21 |
| Last Update Date | 2023-02-24 |