| NPI | 1205455599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 73673) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351046505) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-08-07 |