| NPI | 1427440221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 61124751) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: WA OP61124751) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2022-11-03 |