| NPI | 1881665099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00038373) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD22180) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2018-04-30 |