| NPI | 1659399707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 44802) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 44312-20) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-03-01 |