| NPI | 1194067371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2026001559) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A133235) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2026-04-02 |