| NPI | 1104093251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60222478) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 54208) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2013-02-12 |