| NPI | 1770573669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 40368) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AK 5110) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2025-05-01 |