| NPI | 1174918478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61455551) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD192800) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2023-07-25 |