| NPI | 1568440576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 44138) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 44138) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MN 44138) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2022-10-31 |