| NPI | 1407265218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60840028) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301105031) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2020-12-23 |