| NPI | 1992139117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 61062122) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101257209) |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2024-06-22 |