| NPI | 1003872748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AK 4491) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 32525) |
| 207P00000X Emergency Medicine (Licence: CA G64110) | |
| 207R00000X Internal Medicine (Licence: AK 4491) | |
| 207R00000X Internal Medicine (Licence: WA 32525) | |
| 207R00000X Internal Medicine (Licence: CA G64110) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-08 |