| NPI | 1770565533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 54902) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2004030782) |
| 207P00000X Emergency Medicine (Licence: KS 431182) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2021-01-07 |