| NPI | 1205099157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.205940) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS AU5009697-1291) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2021-01-06 |