| NPI | 1336406792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60866067) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 16115) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2021-01-07 |