| NPI | 1053678086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A127380) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 53976) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2021-01-08 |