| NPI | 1336160571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60636094) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD21165) |
| 207P00000X Emergency Medicine (Licence: CA C54418) | |
| 207P00000X Emergency Medicine (Licence: WI 54948-20) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2021-04-13 |