| NPI | 1053310086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60569749) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 33682) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2024-07-25 |