| NPI | 1538465398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 55351) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 261133-1) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2012-11-27 |