| NPI | 1720341225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 63763-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 59212) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2015-05-18 |