| NPI | 1477636900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00042203) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD193545) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-10-09 |