| NPI | 1285862045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 22013) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 57126) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2019-05-13 |