| NPI | 1659367142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME63604) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00038408) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2013-07-12 |