| NPI | 1225289689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 10494) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 10494) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2024-10-28 |