| NPI | 1053843771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61024606) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ND 16628) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2022-10-10 |