| NPI | 1649635095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A157750) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: MD D80655) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2026-08-11 |