| NPI | 1871621607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00048109) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 222336) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2009-02-24 |