| NPI | 1134302995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD 60064119) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 23979) |
| 207P00000X Emergency Medicine (Licence: NE 23979) | |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2010-08-16 |