| NPI | 1356379721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 46339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 46339) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-01-18 |