| NPI | 1790756815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 10104037-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60130455) |
| 208D00000X General Practice (Licence: NE 23355) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2025-01-29 |