| NPI | 1124196506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA G75473) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MD d43476) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MD d43476) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2013-02-18 |