| NPI | 1679937452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 71382-21) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 65729) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2019-07-18 |