| NPI | 1851369664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 102657) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00033876) |
| 207P00000X Emergency Medicine (Licence: WI 42410-20) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2015-03-26 |