| NPI | 1174514582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA G57870) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 49623) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2025-06-16 |