| NPI | 1184967994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD 60676866) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 71667) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2023-01-25 |