| NPI | 1649681222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 61454) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 67786) |
| 207R00000X Internal Medicine (Licence: MN 61454) | |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2025-07-18 |