| NPI | 1184910218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 57794) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 61923-20) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2022-09-08 |