| NPI | 1669442406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 56179) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102201761) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2021-01-14 |