| NPI | 1659630309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 59331) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 64089-20) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2022-05-09 |