| NPI | 1619328648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61068604) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2016017318) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2020-09-29 |