| NPI | 1053548933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 63384) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA DO-4437) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2018-06-14 |