| NPI | 1962477513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 43488) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 60298) |
| 207P00000X Emergency Medicine (Licence: WI 43262) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2018-05-29 |