| NPI | 1235541756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 70309) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL13250) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2022-03-30 |