| NPI | 1407140403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 59285) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 64282-20) |
| 207P00000X Emergency Medicine (Licence: PA 198856) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2019-05-10 |