| NPI | 1972709368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60131822) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM RS2007-0308) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2010-07-08 |