| NPI | 1770581332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60267048) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 11004) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2021-06-18 |