| 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 |