| NPI | 1578592820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 105790) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 48135-020) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2011-09-27 |