| NPI | 1780035279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 65309) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 76132-20) |
| Enumeration Date | 2016-06-26 |
| Last Update Date | 2026-06-02 |