| NPI | 1740840784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 71024) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019454) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2022-09-19 |