| NPI | 1245265966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA G48913) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G48913) |
| 207P00000X Emergency Medicine (Licence: MO 108085) | |
| 207P00000X Emergency Medicine (Licence: MS 15151) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA G48913) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA G48913) | |
| 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA G48913) | |
| 208D00000X General Practice (Licence: CA G48913) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA G48913) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-09-22 |