| NPI | 1265471817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00034032) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID MC-1150) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-01-04 |