| NPI | 1124052493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 51790) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 36403) |
| 207P00000X Emergency Medicine (Licence: ME 017622) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2010-03-18 |