| NPI | 1912057472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 60131079) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 23942) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2014-10-29 |