| NPI | 1679940332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 009150) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A16120) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2021-07-06 |