| NPI | 1609442052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20a21758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 4125) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2026-05-13 |