| NPI | 1366982456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD221792) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD61089403) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2025-12-15 |