| NPI | 1336676279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 64074) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87114-20) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2026-03-30 |