| NPI | 1558757674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 70743) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 36923) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2022-06-30 |