| NPI | 1487699013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: CA C55209) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101230922) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2021-02-24 |