| NPI | 1548210503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 45732) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00045732) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2026-01-15 |