| NPI | 1649234956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 47548) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87801-20) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2026-07-24 |