| NPI | 1588645683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61360462) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 20667) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2023-10-12 |