| NPI | 1346814951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 71954) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 88018-20) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2026-09-09 |