| NPI | 1760540801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60768791) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID O-231) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2018-03-17 |