| NPI | 1215136627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 52871) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301090711) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2020-12-04 |