| NPI | 1578862157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61129047) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A138024) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2022-06-15 |