| NPI | 1598749335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00016105) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 46964) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2019-10-23 |