| NPI | 1477685121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 102918) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 52126) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2024-04-09 |