| NPI | 1104814680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A104007) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME0091008) |
| 207P00000X Emergency Medicine (Licence: NC 200400247) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2015-01-21 |