| NPI | 1881634988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 57195) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 12000) |
| 207Q00000X Family Medicine (Licence: TN 12000) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2018-03-17 |