| NPI | 1295715860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 43382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 43382) |
| 207P00000X Emergency Medicine (Licence: MN 58894) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2020-10-07 |