| NPI | 1477732659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2001031034) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 34889) |
| 207P00000X Emergency Medicine (Licence: WI 66431) | |
| 207P00000X Emergency Medicine (Licence: KS 0427454) | |
| 207P00000X Emergency Medicine (Licence: CO DR.0056136) | |
| 207P00000X Emergency Medicine (Licence: MN 60244) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2021-01-19 |