| NPI | 1639133374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 51395) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: WI 49779) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2010-11-29 |