| NPI | 1679261580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 78068) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 33420) |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2024-09-11 |