| NPI | 1154352508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 23102) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00033855) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-04-18 |