| NPI | 1841587128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 57665) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 70922-20) |
| 207Q00000X Family Medicine (Licence: MN 57665) | |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2023-12-07 |