| NPI | 1265448245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-01900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 38703) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MN 38703) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2012-05-11 |