| NPI | 1194475764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 74665) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 32625) |
| Enumeration Date | 2022-03-26 |
| Last Update Date | 2025-07-01 |