| NPI | 1225091507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60037377) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2017043979) |
| 207P00000X Emergency Medicine (Licence: WV 2737) | |
| 207P00000X Emergency Medicine (Licence: CA 20A8234) | |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2022-04-20 |