| NPI | 1639517972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA C178972) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME126436) |
| 207P00000X Emergency Medicine (Licence: FL 19020) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME126436) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2022-09-12 |