| NPI | 1447446596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61618641) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101247851) |
| Enumeration Date | 2007-09-22 |
| Last Update Date | 2025-11-10 |