| NPI | 1770809733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD167815) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 56578) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2014-09-01 |