| NPI | 1508359886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 68617) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME149521) |
| 207P00000X Emergency Medicine (Licence: WI 87421-20) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2026-06-28 |