| NPI | 1922627462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 70146) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 30788) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2023-06-21 |