| NPI | 1225887664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 80524) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 34244) |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2025-08-26 |