| NPI | 1164469698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 34349) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00043539) |
| 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-34349) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2025-07-11 |