| NPI | 1508908369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME121393) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 00018398) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2018-08-01 |