| NPI | 1205835469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 56163) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 051637) |
| 207Q00000X Family Medicine (Licence: MI 4301051637) | |
| 207Q00000X Family Medicine (Licence: KS 432455) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2019-06-11 |