| NPI | 1306097928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 106348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY TL1362) |
| 208600000X Surgery (Licence: MI 4301092736) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2012-09-27 |