| NPI | 1043365067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00047622) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT 11928) |
| 207P00000X Emergency Medicine (Licence: AZ 35686) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2019-03-05 |