| NPI | 1699122887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: WA MD61061544) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD61061544) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2025-07-24 |