| NPI | 1215972930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00024878) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 54388-20) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2012-09-27 |