| NPI | 1528599917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 64157) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87089-20) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-04-16 |