| NPI | 1326359456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 58259) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MN 58259) |
| 207P00000X Emergency Medicine (Licence: WI 64819-20) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2023-08-01 |