| NPI | 1164612651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 51269) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 16839) |
| 207P00000X Emergency Medicine (Licence: MN 103711) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2009-03-04 |