| NPI | 1215319694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 63097) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 82224-21) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2026-07-09 |