| NPI | 1366935363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 70946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 70946) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2023-07-18 |