| NPI | 1154689370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 59400) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 108186) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-07-21 |