| NPI | 1609506468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4351050101) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A201085) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2025-07-24 |