| NPI | 1306580063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 32987) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 85516) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2025-07-18 |