| NPI | 1790780302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 36942) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 40948) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2019-12-09 |