| NPI | 1144213455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID M-8310) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD61084253) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2021-11-04 |