| NPI | 1245679158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60727543) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2013020131) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2019-10-01 |