| NPI | 1912326836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA TD61442314) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ND 21697) |
| 207P00000X Emergency Medicine (Licence: MT MED-PHYS-COM-LIC-158) | |
| 207P00000X Emergency Medicine (Licence: WY 15714A) | |
| 207P00000X Emergency Medicine (Licence: NV 27283) | |
| 207P00000X Emergency Medicine (Licence: CA C179538) | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2025-09-05 |