| NPI | 1669727665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61583502) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID O-0869) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2025-07-21 |