| NPI | 1336582998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 67408) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301103036) |
| Enumeration Date | 2013-04-14 |
| Last Update Date | 2020-06-18 |