| NPI | 1184851305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60424851) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT01307) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2014-10-28 |