| NPI | 1578875464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 56134) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 60746-20) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2019-05-10 |