| NPI | 1356616858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO180483) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA OP60861134) |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2022-02-04 |