| NPI | 1659875003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 68968) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 75578-21) |
| 207P00000X Emergency Medicine (Licence: SC STUDENT) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2021-08-10 |