| NPI | 1104195916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A123764) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M-13191) |
| 207P00000X Emergency Medicine (Licence: OR MD170843) | |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2022-05-24 |