| NPI | 1063776078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 60950236) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036.137163) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2019-06-24 |