| NPI | 1154683787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A134524) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301100639) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2017-10-30 |