| NPI | 1659948073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 79855) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 86022-20) |
| 207P00000X Emergency Medicine (Licence: MI 4301511118) | |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2025-06-30 |