| NPI | 1659808665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 66997) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 73162) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2021-10-14 |