| NPI | 1831485564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 55503) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 52399) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2020-10-09 |