| NPI | 1114161692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60414696) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD60414696) |
| 207P00000X Emergency Medicine (Licence: TX N2523) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX N2523) | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2026-05-06 |