| NPI | 1699156208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD70039207) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD461395) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2026-08-07 |