| NPI | 1740354984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 55122) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 253219-1) |
| 207P00000X Emergency Medicine (Licence: WI 51441020) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2013-04-11 |