| NPI | 1962559567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA PA10005135) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA01307) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2008-05-21 |