| NPI | 1114248192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 55343) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 68455) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2026-05-07 |