| NPI | 1619261021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NV SL0811) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A12514) |
| 207P00000X Emergency Medicine (Licence: UT 8979066-1204) | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2014-11-12 |