| NPI | 1649480088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00048963) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR LL16358) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2008-01-28 |