| NPI | 1215989736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 47764) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 50496) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2019-05-10 |