| NPI | 1245209949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00036669) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101051706) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2008-05-23 |