| NPI | 1972956746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61452016) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301110533) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2025-07-24 |