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 |