| NPI | 1710153986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 52353) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 54882-020) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2018-06-18 |