| NPI | 1639149966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP00002147) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A7130) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2025-07-10 |