| NPI | 1922682624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 73765) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 83926) |
| Enumeration Date | 2021-05-08 |
| Last Update Date | 2024-07-01 |