NPI | 1679960595 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 65751) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME137398) |
Enumeration Date | 2015-04-17 |
Last Update Date | 2023-04-13 |