| NPI | 1043679699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 123456) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA DO-05356) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2020-04-30 |