| NPI | 1114288560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60648272) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS018199) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2022-01-11 |