| NPI | 1689788457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61280247) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L5967) |
| 207P00000X Emergency Medicine (Licence: OR MD189241) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2022-10-11 |