| NPI | 1215908488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD20306) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00046822) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-08-16 |