| NPI | 1316202476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 61617542) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 56725) |
| 207P00000X Emergency Medicine (Licence: WI 62573) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2025-07-11 |