| NPI | 1174763452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 54257) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 256862-1) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2011-08-18 |