| NPI | 1528187911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 49752) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD439437) |
| 207P00000X Emergency Medicine (Licence: NH 15623) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-10-07 |