| NPI | 1649617358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60752542) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL35668) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2022-01-28 |