| NPI | 1154736734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A14461) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA OP60812121) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2022-05-18 |