| NPI | 1770689911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00048095) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301074254) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 074254) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2008-07-09 |