| NPI | 1194929455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 55174) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 82255-21) |
| 207P00000X Emergency Medicine (Licence: MI 5101017181) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2026-07-17 |