| NPI | 1336842079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD.MD.70111860) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD.MD.70111860) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-07-27 |