| NPI | 1851602387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 58533) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101018771) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2020-12-11 |