| NPI | 1316175961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101253559) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD61136531) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2025-07-14 |