| NPI | 1649651803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A154657) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT209155) |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2019-07-07 |