| NPI | 1649831942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 71784) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT219409) |
| 207P00000X Emergency Medicine (Licence: PA MD476273) | |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2022-06-30 |