| NPI | 1336317015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60133290) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI L1159447) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2021-05-03 |