| NPI | 1538470489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 56310) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 60301-20) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2013-07-12 |