| NPI | 1639794134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A186156) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT220757) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2023-06-12 |