| NPI | 1639431133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60546517) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R73282) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2015-11-03 |