| NPI | 1790426245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD70079631) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MS 35073) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2026-06-18 |