| NPI | 1649405630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 56265) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 24465) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2024-09-17 |