| NPI | 1689019911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 60634619) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA C183502) |
| 207P00000X Emergency Medicine (Licence: CO DR.0070214) | |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2023-07-20 |