| NPI | 1053725754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 67207) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 54122) |
| 207P00000X Emergency Medicine (Licence: WI 73868-20) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2020-09-20 |