| NPI | 1639123060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60180350) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD16174) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2021-04-28 |