| NPI | 1215519822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A-20499) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA PTL1964) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2026-04-06 |