| NPI | 1134788599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 68442) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 56406) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2022-12-12 |