| NPI | 1821019811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 60244738) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200500322) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 200500322) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2012-02-06 |