| NPI | 1104189414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A15281) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020070) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2021-11-10 |