| NPI | 1023631348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 61400323) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT220663) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2023-05-02 |