| NPI | 1043356033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA C35744) |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care (Licence: CA C35744) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2025-07-15 |