| NPI | 1851662936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD.MD.61283530) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 99621) |
| 208D00000X General Practice (Licence: VA 0101254504) | |
| 207P00000X Emergency Medicine (Licence: GU M-2187) | |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2024-05-26 |