| NPI | 1194170407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A157667) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A157667) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2026-02-03 |