| NPI | 1831570373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 63787) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 69414-20) |
| 207P00000X Emergency Medicine (Licence: PA MT208659) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2020-08-19 |