| NPI | 1619555703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61540098) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87307-20) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WI 87307-20) | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2026-05-16 |