| NPI | 1669410486 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60191712) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AK AA2499) |
| 207R00000X Internal Medicine (Licence: AK AA2499) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2022-11-07 |