| NPI | 1639123409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 78050) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.063506) |
| 207P00000X Emergency Medicine (Licence: FL ME94632) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2024-11-25 |