| NPI | 1780889576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 63144) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 140937) |
| 207P00000X Emergency Medicine (Licence: MS 21852) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2018-03-17 |