| NPI | 1740457902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MN 51422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 12193) |
| 207Q00000X Family Medicine (Licence: MN 51422) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2013-10-10 |