| NPI | 1003273384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 58905) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A177113) |
| 207P00000X Emergency Medicine (Licence: TN 70707) | |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2026-04-30 |