| NPI | 1700832771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00044707) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD27306) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2010-10-26 |