| NPI | 1104137868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60334218) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R72189) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2021-04-07 |