| NPI | 1063436350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA md00025107) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA md00025107) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |