| NPI | 1558397638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301080155) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD 60041418) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2018-09-12 |