| NPI | 1194011148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 57524) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 61856-20) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2019-05-10 |