| NPI | 1689963852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60514633) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD162447) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2015-12-14 |