| NPI | 1710795257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 95034131) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 95035569) |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2025-04-26 |