| NPI | 1376885772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 60691) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 86149) |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2025-07-24 |