| NPI | 1952698516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 77344) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: HI MD17442) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2025-04-15 |