| NPI | 1578133765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 80012) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2021019858) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2025-07-07 |