| NPI | 1538112511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 56653) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 31075) |
| 207P00000X Emergency Medicine (Licence: MN 106902) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-03-07 |