| NPI | 1760649826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 53908) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 49500) |
| 207P00000X Emergency Medicine (Licence: CO 2412) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2022-11-18 |