| NPI | 1962606012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 9895821-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60245633) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2019-02-21 |