| NPI | 1477132314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 183054) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 183054) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2025-06-05 |