| NPI | 1477085785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 199736) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101268365) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2026-08-06 |