| NPI | 1508203829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 57961) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2016011906) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2019-12-17 |