| NPI | 1689962482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60452878) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R72565) |
| 207P00000X Emergency Medicine (Licence: AZ 46767) | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2015-12-16 |