| NPI | 1760406771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID M6077) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00030099) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2011-10-27 |