| NPI | 1801863964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 45250) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 46995) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2007-07-08 |