| NPI | 1912029141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 58776) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301083984) |
| 207P00000X Emergency Medicine (Licence: WI 51625) | |
| 207P00000X Emergency Medicine (Licence: AZ 50155) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-09-10 |