| NPI | 1962666271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 73779) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 53878) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2020-10-05 |