| NPI | 1346479805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 55088) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301094907) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2012-08-07 |