| NPI | 1063482073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 48077) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 97644) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2012-02-13 |