| NPI | 1184042137 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A161393) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 64795 - 20) | 
| 207P00000X Emergency Medicine (Licence: CT 56102) | |
| Enumeration Date | 2014-04-06 | 
| Last Update Date | 2024-03-21 |