| NPI | 1851597090 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 877289) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 50928) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2022-08-18 |