| NPI | 1235290305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD 60074977) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT184099) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2009-04-30 |