| NPI | 1649405671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD159208) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60292835) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2026-03-19 |