| NPI | 1629495833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 61518892) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 51008) |
| 207P00000X Emergency Medicine (Licence: NV 23560) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: WA 61518892) | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2024-08-22 |