| NPI | 1619022415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60396582) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102201745) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-07-20 |