| NPI | 1730185497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00043900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 5450A) |
| 207P00000X Emergency Medicine (Licence: HI 12638) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2012-05-03 |