| NPI | 1063753440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60749006) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020396) |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2024-04-09 |