| NPI | 1821650391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61182905) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 1908-R77732) |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2025-09-25 |