| NPI | 1629055124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 30072) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MN 30072) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2014-10-16 |