| NPI | 1972714483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CO 18782) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60011986) |
| 207P00000X Emergency Medicine (Licence: MA 238441) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2009-01-13 |