| NPI | 1467864124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61050678) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 1467864124) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2023-05-31 |