| NPI | 1386025609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 68934-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 63650) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2018-10-05 |