| NPI | 1205451192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 723882) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-11983) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2023-07-21 |