| NPI | 1629311485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D97672) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 60565508) |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2023-09-29 |