| NPI | 1508884925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 73155) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2003004588) |
| 208D00000X General Practice (Licence: MO 2003004588) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-10-18 |