| NPI | 1295886802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 49952) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301083469) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2016-02-01 |