| NPI | 1164860318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 61061) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-9813) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2022-07-21 |