| NPI | 1538540828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61184051) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT209654) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2026-06-05 |