| NPI | 1518609486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A195131) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 210847) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G143626) | |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2025-06-16 |