| NPI | 1174010516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 68941) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: MN 68941) |
| 207P00000X Emergency Medicine (Licence: WI 75896) | |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2025-04-09 |