| NPI | 1588286819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA DO.OP.70094976) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R3405) |
| 207P00000X Emergency Medicine (Licence: AZ R3405) | |
| 207P00000X Emergency Medicine (Licence: OK 7659) | |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2026-05-22 |