| NPI | 1215318522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60823326) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2015017273) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-02-24 |