| NPI | 1023379179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 72205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301100921) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2022-12-15 |