| NPI | 1376040097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A185561) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101272175) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2025-09-17 |