| NPI | 1619956109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200201454) |
| Additional Taxonomies | 101Y00000X Counselor |
| 133V00000X Dietitian, Registered | |
| 175F00000X Naturopath | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 200201454) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2025-01-15 |