| NPI | 1831688928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61272916) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2021-02386) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2022-03-23 |