| NPI | 1578509147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61379239) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD24569) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2023-02-22 |