| NPI | 1508097320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD.MD.60823672) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 099003) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2021-04-28 |