| NPI | 1205147600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD 60359938) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R72195) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2013-08-13 |