| NPI | 1619078953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP00001147) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR DO14350) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2011-12-13 |