| NPI | 1558898684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MN 64091) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 64091) |
| 207P00000X Emergency Medicine (Licence: NC 2021-01249) | |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2022-06-21 |