| NPI | 1871237560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 78891) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87618-20) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2026-06-11 |