| NPI | 1942697990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 79208) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 292418) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2025-07-24 |