| NPI | 1447394622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 49579) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87604-20) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2026-07-09 |