| NPI | 1689887929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD601082274) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 13670) |
| 207P00000X Emergency Medicine (Licence: OR MD28973) | |
| 207P00000X Emergency Medicine (Licence: AK 6316) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2019-11-07 |