| NPI | 1972533263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 38763) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 57087-20) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-05-26 |