| NPI | 1861664153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 20440) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 54228-20) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2019-05-13 |