| NPI | 1053874305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: CA A184909) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A184909) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2026-06-15 |