| NPI | 1487175170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MN 71404) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 75557) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-08-25 |