| NPI | 1639865413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 82564) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 84981-20) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2026-07-07 |