| NPI | 1538422159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101020022) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A16525) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2018-07-02 |