| NPI | 1184282154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61442795) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019151) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2023-10-30 |