| NPI | 1457441719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD.MD.60132122) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 221439) |
| 207P00000X Emergency Medicine (Licence: OR MD28233) | |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2010-06-23 |