| NPI | 1508445297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM DO2025-0091) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A24575) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2026-09-15 |