| NPI | 1417506445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: HI AMD-1106) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA58088) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2022-02-11 |