| NPI | 1659577856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 52290) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 59882) |
| 207P00000X Emergency Medicine (Licence: NY 244041) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2018-06-07 |