| NPI | 1043654643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 58149) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 58149) |
| 207P00000X Emergency Medicine (Licence: WI 66289-21) | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2024-06-20 |