| NPI | 1013170869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60733583) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301092664) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2018-01-10 |