| NPI | 1891114492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61133680) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 6813) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2021-11-24 |