| NPI | 1598100638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT015032) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA OP60702070) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2025-07-08 |