| NPI | 1750423539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 00039757) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00039757) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2023-08-31 |