| NPI | 1386273332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 73719) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 82342) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-03-28 |