| NPI | 1316575400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 74240) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 77540) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-03-25 |