| NPI | 1952832669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 72203) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 64071) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2020-10-16 |