| NPI | 1053940841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 73439) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301506940) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2023-08-21 |