| NPI | 1013951532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00037985) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID 7371555) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2025-06-02 |