| NPI | 1104880236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 66373) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 25719-020) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2021-04-08 |