| NPI | 1588606735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 50872) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-06-5174-K) |
| 207P00000X Emergency Medicine (Licence: OH 35.065174) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2019-03-11 |