| NPI | 1417029661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA op00001105) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: AZ 2910) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2015-07-01 |