| NPI | 1124682596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MN 73540) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: MN 73540) |
| 207P00000X Emergency Medicine (Licence: WI 83508) | |
| 207P00000X Emergency Medicine (Licence: MN 73540) | |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2026-06-26 |